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Use of the continuity equation for transesophageal Doppler assessment of severity of proximal left coronary artery stenosis: a quantitative coronary angiography validation study

^a Division of Cardiology, Hôpital Nord, University Jean Monnet, Saint Etienne, France

View larger version (70K): [in a new window]   Figure 1 Examples of transesophageal Doppler coronary flow recording in two different patients with stenosis of the proximal part of the LAD. A, Example of a patient with a moderate stenosis of the proximal part of the LAD. Left panel, Color Doppler flow mapping; note the changes in the color flow map, with blue indicating low velocities in front of the stenosis and a typical localized color aliasing at the site of the stenosis. Right upper panel, Pulsed Doppler recording upstream from the zone of color aliasing (prestenotic area); the peak diastolic velocity is 49 cm/s and the diastolic TVI is 25 cm. Right lower panel, High pulse repetition frequency Doppler recording of velocities at the site of color aliasing (stenotic area); velocities are significantly increased, with a peak diastolic velocity of 182 cm/s and a TVI of 64 cm. B, Example of a patient with a critical stenosis of the proximal part of the LAD. In this patient, only the diastolic velocity wave tracing can be well delineated. Upper panel, Pulsed Doppler recording in the prestenotic area; the peak diastolic velocity is 26 cm/s and the diastolic TVI is 12 cm. Lower panel, High pulse repetition frequency Doppler echocardiography allows the recording of velocities at the site of the stenotic area as high as 4 m/s, with a TVI of 198 cm. S = systolic wave; D = diastolic wave.

View larger version (27K): [in a new window]   Figure 2 Relation between the catheterization-derived MLD and the TEDE-derived peak diastolic velocity across the stenosis.

View larger version (27K): [in a new window]   Figure 3 Upper panel, Relation between catheterization-derived percent CSA stenosis and TED-derived percent CSA stenosis, using the continuity equation. Lower panel, Plot of the difference of the values obtained by the two methods versus the mean of the values. QCA = quantitative coronary angiography. TED = transesophageal Doppler echocardiography.

View larger version (26K): [in a new window]   Figure 4 Upper panel, Relation between catheterization-derived percent CSA stenosis and TED-derived percent CSA stenosis, using the corrected continuity equation (i.e., by dividing the prestenotic TVI by 2). Lower panel, Plot of the difference of the values obtained by the two methods versus the mean of the values. QCA = quantitative coronary angiography; TED = transesophageal Doppler echocardiography.

View larger version (19K): [in a new window]   Figure 5 Upper panel, Relation between catheterization-derived percent DS and the TED-derived ratio of prestenotic to stenotic VTIs. Lower panel, Individual data for the ratios of prestenotic to stenotic TVIs in patients subclassified according to the catheterization-derived percent DS (<50% or 50%). TED = transesophageal Doppler echocardiography.